Case report Mitral balloon valvuloplasty during pregnancy in developing countries Dilek Uygur * , M. Sinan Beksac Ë Department of Obstetrics and Gynecology, School of Medicine, Hacettepe University, 06100 Ankara, Turkey Received 20 March 2000; received in revised form 12 June 2000; accepted 18 July 2000 Abstract Two women presented with severe mitral stenosis at 28th and 23rd weeks of gestation, respectively. Both did not respond to medical therapy and percutaneous balloon valvuloplasty was performed during pregnancy successfully. While one of the women gave no history of cardiac disease the other had already underwent balloon valvuloplasty twice due to restenosis of the mitral valve. The rest of their pregnancies were both uncomplicated. They discontinued their medication. Both were able to deliver vaginally at term. Percutaneous balloon valvuloplasty is a promising approach to the treatment of patients with rheumatic mitral stenosis if medical management is unsuccessful. # 2001 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Pregnancy; Mitral stenosis; Balloon valvuloplasty 1. Introduction Cardiac disease complicates about 1% of all pregnancies [1]. Rheumatic mitral valve stenosis is the most common form of organic heart disease encountered during pregnancy [2,3]. Severe and uncorrected valvular heart disease is relatively infrequent in developed countries [4]. However, it is still an important problem of developing countries as it contributes to maternal and fetal mortality. Patients who fail to improve on medical management should be considered for surgical therapy. Percutaneous balloon valvuloplasty is a therapeutic alternative to surgical mitral commissurotomy or valve replacement in selected patients. We present our two cases with severe mitral valve stenosis during pregnancy who were treated with balloon valvulo- plasty. 2. Case 1 A 33-year-old woman admitted to another hospital due to dyspnea, occasional chest pain, edema and limitation of daily activity. By New York Heart Association criteria the patient had class III symptoms of congestive heart failure. She was at 28 weeks of gestational age. She had no history of cardiac disease. On physical examination, she had blood pressure of 110/70 mmHg, heart rate of 92 bpm in sinus rhythm and respiration of 16 bpm. Her chest X-ray showed left atrial enlargement. Echocardiography revealed enlarge- ment of right ventricle and both atria, minimally calci®ed stenotic mitral valve valve area: 0.9 cm 2 , mitral gradient: 24 mmHg), pulmonary hypertension 62 mmHg) and mild tricuspid and mitral regurgitation. Obstetrical ultrasound showed a single fetus whose biometric measurements were consistent with 28 weeks of gestation. Her obstetric history showed two vaginal deliveries at term. She was placed on digoxin 0.25 mg per day, furosemide 40 mg per day and acebutalol 2 100 mg per day. After 1 week of medical therapy, her symptoms improved little and decision for balloon valvuloplasty was made. The procedure was per- formed following local anesthesia and prophylaxis with ampicillin/gentamicin. The abdomen was shielded from ¯uoroscope and an external fetal monitoring was used. A 6-French sheath was placed in the left femoral artery and an 8-French sheath was placed in the right femoral vein. After dilating the atrial septum, a de¯ated 26 mm balloon was passed through the septum and placed to the mitral ori®ce. The 26 mm balloon was in¯ated until the indentation in the balloon created by the stenotic valve was disappeared. There happened to be a transient decrease in fetal heart rate from 140 to 110 bpm that returned back to 140 bpm in a few minutes of balloon de¯ation. Echocardiography after the procedure showed a mitral valve area of 2 cm 2 , minimal European Journal of Obstetrics & Gynecology and Reproductive Biology 96 2001) 226±228 * Tel.: 90-312-2879882; fax: 90-312-4424136. E-mail address: uygurdc@superonline.com D. Uygur). 0301-2115/01/$ ± see front matter # 2001 Elsevier Science Ireland Ltd. All rights reserved. PII:S0301-211500)00458-9